Knee Surgery and Related Research最新文献

{"title":"Relationship between muscle activation and sagittal knee joint biomechanics in patients with patellofemoral pain syndrome: a cross-sectional study.","authors":"Byung Sun Choi, Soon Bin Kwon, Sehyeon Jeon, Myeongjun Kim, Yunseo Ku, Du Hyun Ro, Hyuk-Soo Han","doi":"10.1186/s43019-025-00259-4","DOIUrl":"10.1186/s43019-025-00259-4","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral pain syndrome (PFPS) is one of the most common conditions affecting the knee joint, yet its pathomechanics remain unclear. The aim of this study was to investigate changes in muscle activation and gait patterns and to analyze the relationship between muscle activation and kinetic gait patterns in patients with PFPS.</p><p><strong>Methods: </strong>This study included 31 patients with PFPS and 28 healthy volunteers without any symptoms. The sagittal plane motion of the knee joint, representing primary movement of the knee joint, was evaluated to identify changes in gait patterns. Electromyography (EMG) was used to measure muscle activation of vastus medialis (VM), vastus lateralis (VL), semitendinosus (ST), and gastrocnemius (GCM) muscles during gait analysis. Biomechanical features were analyzed during the three phases of the gait cycle; weight acceptance (WA), single limb support (SLS), and swing limb advancement (SLA) (0 ~ 12%, 13 ~ 50%, and 51 ~ 100% of the gait cycle, respectively).</p><p><strong>Results: </strong>The average knee extension moment (KEM) during WA was lower in the patient group and no significant differences were observed in the knee flexion angle (KFA). With respect to muscle activation, the patient group showed significantly higher muscle activation of the ST muscle in all phases. As the absolute value of the moment increased, the activation of the VM, VL, and ST muscles increased more rapidly in the patient group, especially when KEM was under -1% body weight × height (Bw × Ht) or over 5% Bw × Ht.</p><p><strong>Conclusions: </strong>Patients with PFPS exhibit elevated muscle activation, particularly in response to changes in the knee extension moment, which is likely a compensatory mechanism to manage knee joint loading during gait. These results highlight altered neuromuscular adaptations in PFPS, suggesting targeted therapies may help improve functional outcomes. Level of evidence III, cross-sectional study.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"37 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Pathologically altered articular cartilage attracts intense chondrocyte invasion into the extracellular matrix: in vitro pilot study.","authors":"Victoria A Shestakova, Ilya D Klabukov, Ilya V Kolobaev, Longfeng Rao, Dmitry A Atiakshin, Michael A Ignatyuk, Mikhail E Krasheninnikov, Bagavdin G Ahmedov, Sergey A Ivanov, Peter V Shegay, Andrey D Kaprin, Denis S Baranovskii","doi":"10.1186/s43019-024-00253-2","DOIUrl":"10.1186/s43019-024-00253-2","url":null,"abstract":"","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"37 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-stage revision anterior cruciate ligament reconstruction reduces failure risk but leads to lesser clinical outcomes than single-stage revision after primary anterior cruciate ligament graft failure: a retrospective cohort study.","authors":"Anna M Ifarraguerri, George D Graham, Alexander B White, Alexander N Berk, Kennedy K Gachigi, Patrick N Siparsky, David P Trofa, Dana P Piasecki, James E Fleischli, Bryan M Saltzman","doi":"10.1186/s43019-024-00257-y","DOIUrl":"10.1186/s43019-024-00257-y","url":null,"abstract":"<p><strong>Background: </strong>There are no studies that compare the outcomes and complications of single-versus two-stage revision anterior cruciate ligament reconstruction (ACLR) after primary ACLR failure. This purpose of this study is to examine clinical and functional outcomes and complications associated with single and two-stage revision ACLR after primary ACLR failure.</p><p><strong>Methods: </strong>All patients who underwent single or two-stage revision ACLR after primary ACLR failure between 2012 and 2021 with a minimum of a 2 year follow-up were included. Patients were excluded if they were not treated at our single academic institution, had inadequate follow-up, or had incomplete medical records. Revision intraoperative data, concomitant injuries, and complications were collected by chart review. Return to sport, numerical pain rating scale (NPRS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Veteran Rands 12-item health survey (VR-12 scores) were collected.</p><p><strong>Results: </strong>The final analysis included 176 patients. A total of 147 (83.5%) had a single-stage revision ACLR (87 male, 60 female), and 29 (16.5%) had a two-stage revision ACLR (13 male, 16 female). Two-stage revision ACLR was significantly associated with anterior knee pain [odds ratio (OR) 4.36; 95% confidence interval (CI) 1.5 to 12.65; P = 0.007] but with lower failure rates (OR 0.12, 95% CI 0.02 to 0.9; P = 0.04). On multivariate analysis, a two-stage revision ACLR reduced the risk of graft failure by 85% (OR 0.15; 95% CI 0.02 to 1.17; P = 0.07). Two-stage revision ACLR was significantly associated with a lower KOOS pain score (OR -11.7; 95% CI -22.35 to -1.04; P = 0.031), KOOS symptoms score (OR -17.11; 95% CI -28.85 to -5.36; P = 0.004), KOOS Activities of Daily Living (ADL) score (OR -11.15; 95% CI -21.71 to -0.59; P = 0.039) and Veterans RAND 12-Item Health Survey (VR-12) physical component score (OR -9.99; 95% CI -15.77 to -4.22; P = 0.001).</p><p><strong>Conclusions: </strong>The clinical outcomes and subjective patient scores significantly differed between the single-stage and two-stage revision ACLR after primary ACLR failure. Patients with a two-stage revision ACLR had a significantly reduced risk of revision graft failure but higher rates of postoperative anterior knee pain, lower pain scores, and lesser knee functional scores than single-stage revision patients.</p><p><strong>Study design: </strong>Retrospective cohort study; level of evidence, 3.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"37 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of recurrent periprosthetic joint infection of the knee after two-stage reimplantation.","authors":"Do Weon Lee, Hyuk-Soo Han, Du Hyun Ro","doi":"10.1186/s43019-025-00258-5","DOIUrl":"10.1186/s43019-025-00258-5","url":null,"abstract":"<p><strong>Introduction: </strong>Prosthetic joint infection (PJI) is one of the most common and detrimental complications of total knee replacement arthroplasty (TKA). Despite extensive efforts, including two-stage reimplantation, to eradicate PJI, it still recurs in a substantial number of patients. However, the risk factors of recurrence after two-stage reimplantation of the knee have not been established. In this study, it is hypothesized that there will be certain risk factors of recurrence after two-stage reimplantation for PJI of the knee.</p><p><strong>Materials and methods: </strong>From March 2002 to December 2022, 65 knees that underwent two-stage reimplantation for PJIs in a single, tertiary hospital were retrospectively reviewed, and 44 patient-related, laboratory-related, and surgery-related factors, including body mass index, pathogen type, and the usage of transfusions, were selected as the potential risk factors for recurrence. Survival analysis using the Kaplan-Meier method and subsequent Cox proportional hazard regression were performed.</p><p><strong>Results: </strong>Out of the 65 knees that underwent two-stage reimplantation, infection recurred in 15 knees (23.1%) in a median 11 (range 4-108) months. The Cox proportional hazards regression showed that infection of revision TKA, mixed pathogen-type infection, and higher serum erythrocyte sedimentation rate (ESR, mm/h) level increases the risk of recurrence (p-values < 0.001, 0.04, and 0.009; hazard ratios 40.29, 1.53, and 1.03, respectively).</p><p><strong>Conclusions: </strong>A significant portion of PJI of the knees recurred after two-stage reimplantation. Revision TKA at the time of initial PJI, mixed pathogen-type infection, and higher serum ESR level were three significant risk factors of PJI recurrence. Surgeons should be more cautious in suspecting PJI relapse for these specific occasions.</p><p><strong>Level of evidence: </strong>III, retrospective cohort study.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"37 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing prediction accuracy for 30-day readmission following primary total knee arthroplasty: the ACS-NSQIP risk calculator versus a novel artificial neural network model.","authors":"Anirudh Buddhiraju, Michelle Riyo Shimizu, Tony Lin-Wei Chen, Henry Hojoon Seo, Blake M Bacevich, Pengwei Xiao, Young-Min Kwon","doi":"10.1186/s43019-024-00256-z","DOIUrl":"10.1186/s43019-024-00256-z","url":null,"abstract":"<p><strong>Background: </strong>Unplanned readmission, a measure of surgical quality, occurs after 4.8% of primary total knee arthroplasties (TKA). Although the prediction of individualized readmission risk may inform appropriate preoperative interventions, current predictive models, such as the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator (SRC), have limited utility. This study aims to compare the predictive accuracy of the SRC with a novel artificial neural network (ANN) algorithm for 30-day readmission after primary TKA, using the same set of clinical variables from a large national database.</p><p><strong>Methods: </strong>Patients undergoing primary TKA between 2013 and 2020 were identified from the ACS-NSQIP database and randomly stratified into training and validation cohorts. The ANN was developed using data from the training cohort with fivefold cross-validation performed five times. ANN and SRC performance were subsequently evaluated in the distinct validation cohort, and predictive performance was compared on the basis of discrimination, calibration, accuracy, and clinical utility.</p><p><strong>Results: </strong>The overall cohort consisted of 365,394 patients (training_N = 362,559; validation_N = 2835), with 11,392 (3.1%) readmitted within 30 days. While the ANN demonstrated good discrimination and calibration (area under the curve (AUC)_ANN = 0.72, slope = 1.32, intercept = -0.09) in the validation cohort, the SRC demonstrated poor discrimination (AUC_SRC = 0.55) and underestimated readmission risk (slope = -0.21, intercept = 0.04). Although both models possessed similar accuracy (Brier score: ANN = 0.03; SRC = 0.02), only the ANN demonstrated a higher net benefit than intervening in all or no patients on the decision curve analysis. The strongest predictors of readmission were body mass index (> 33.5 kg/m²), age (> 69 years), and male sex.</p><p><strong>Conclusions: </strong>This study demonstrates the superior predictive ability and potential clinical utility of the ANN over the conventional SRC when constrained to the same variables. By identifying the most important predictors of readmission following TKA, our findings may assist in the development of novel clinical decision support tools, potentially improving preoperative counseling and postoperative monitoring practices in at-risk patients.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"37 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11727824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial, socioeconomic, and payer status disparities in utilization of unicompartmental knee arthroplasty in the USA.","authors":"Suraj A Dhanjani, Jessica Schmerler, Nauman Hussain, Daniel Badin, Uma Srikumaran, Vishal Hegde, Julius K Oni","doi":"10.1186/s43019-024-00227-4","DOIUrl":"10.1186/s43019-024-00227-4","url":null,"abstract":"<p><strong>Background: </strong>Unicompartmental knee arthroplasty (UKA) is a surgical treatment for knee osteoarthritis associated with lower morbidity compared with total knee arthroplasty (TKA) in patients with isolated unicompartmental knee arthritis. As disparities have been noted broadly in arthroplasty care, it follows that such disparities might be present in the utilization of UKA relative to TKA. This study therefore examined racial/ethnic, socioeconomic, and payer status differences in utilization of UKA.</p><p><strong>Methods: </strong>Patients who underwent UKA or TKA between 2016 and 2020 in the National Inpatient Sample were identified. Multivariable Poisson regression models adjusted for hospital geographic region and patient characteristics [age, sex, and Elixhauser Comorbidity Index (ECI)] were used to examine the effect of race/ethnicity, socioeconomic status, and payer status on incidence rate ratio of UKA relative to TKA.</p><p><strong>Results: </strong>Of the 8472 UKA patients and 639,937 TKA patients identified between 2016 and 2020, 8027 (94.7%) UKA patients and 606,028 (94.7%) TKA patients met inclusion criteria. Patients who underwent UKA were significantly younger (63.5 ± 10.7 years) than patients who underwent TKA (66.8 ± 9.5 years; p < 0.001) and had significantly lower ECI scores (1.8 ± 1.5) than patients who underwent TKA (2.2 ± 1.6; p < 0.001). Black patients were less likely to undergo UKA relative to TKA compared with white patients [incidence rate ratio (IRR) 0.64, confidence interval (CI) 0.58-0.71, p < 0.001]. Compared with patients in income quartile 4, patients in income quartiles 1 and 2 underwent UKA at a lower relative rate (IRR 0.85, CI 0.79-0.90, p < 0.001 and IRR 0.87, CI 0.82-0.93, p < 0.001, respectively). Compared with patients with private insurance, patients with Medicare underwent UKA at a lower relative rate (IRR 0.83, CI 0.79-0.88, p < 0.001).</p><p><strong>Conclusions: </strong>Black patients, lower-income patients, and Medicare-insured patients undergo UKA at a lower relative rate than white, higher-income, and privately insured patients, respectively. Further research may help elucidate reasons for these differences and identify targets for intervention.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"37 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11720326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vivo kinematic analysis of failure cases after nonanatomical anterior cruciate ligament reconstruction: a preliminary study.","authors":"Tomofumi Kage, Shuji Taketomi, Tetsuya Tomita, Takaharu Yamazaki, Ryota Yamagami, Kenichi Kono, Kohei Kawaguchi, Ryo Murakami, Takahiro Arakawa, Takashi Kobayashi, Hiroshi Inui, Sakae Tanaka","doi":"10.1186/s43019-024-00254-1","DOIUrl":"10.1186/s43019-024-00254-1","url":null,"abstract":"<p><strong>Background: </strong>Nonanatomical anterior cruciate ligament (ACL) reconstruction occasionally induces ACL failure without an evident injury episode, necessitating revision surgery. Although the in vivo kinematics of ACL deficiency before primary ACL reconstruction are well documented, the kinematics of ACL failure after nonanatomical reconstruction remain unexplored. The aim of this study is to investigate ACL failure kinematics following nonanatomical reconstruction.</p><p><strong>Patients and methods: </strong>This study enrolled three patients with ACL failure after nonanatomical reconstruction, 20 normal and 16 ACL-deficient knees. The anteroposterior (AP) translation of the medial and lateral femoral condyles and center of the femur and femoral rotation relative to the tibia during squatting were evaluated using a two- to three-dimensional registration technique under fluoroscopy.</p><p><strong>Results: </strong>Medial AP translation of the nonanatomically reconstructed knee in one patient showed posterior location and abnormal kinematics compared with the ACL-deficient knees. In contrast, the lateral AP position of the nonanatomically reconstructed knees in two patients were more posteriorly located and showed more abnormal kinematics than the ACL-deficient knees. Central AP translation of the nonanatomically reconstructed knees in two patients was located more posteriorly throughout the range of midflexion. Femoral rotation of the nonanatomically reconstructed knees showed abnormal kinematics compared with that of the normal and ACL-deficient knees.</p><p><strong>Conclusions: </strong>By independently assessing the medial and lateral aspects of the femur, the medial or lateral condyle of the femur of nonanatomically reconstructed knees exhibited a more pronounced abnormality compared with ACL-deficient knees. The femur of the nonanatomically reconstructed knees showed abnormal rotational kinematics. Considering the kinematic aspect, nonanatomical ACL reconstruction should be avoided.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"48"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of platelet-rich plasma alone versus combined with extracorporeal shockwave therapy in athletes with patellar tendinopathy and knee pain: a randomized controlled trial.","authors":"Shun-Wun Jhan, Kuan-Ting Wu, Wen-Yi Chou, Po-Cheng Chen, Ching-Jen Wang, Wen-Chiung Huang, Jai-Hong Cheng","doi":"10.1186/s43019-024-00252-3","DOIUrl":"10.1186/s43019-024-00252-3","url":null,"abstract":"<p><strong>Background: </strong>Patellar tendinopathy, also known as jumper's knee, can significantly impact the quality of daily life for patients due to the associated pain. A randomized controlled trial was investigated the clinical, sonographic, and serum cytokine markers in patellar tendinopathy of athletes following platelet-rich plasma (PRP) or PRP with extracorporeal shockwave therapy (ESWT) treatments. Our aims to investigate and compare therapeutic effects of PRP versus a combination of PRP with ESWT for treating patellar tendinopathy.</p><p><strong>Methods: </strong>A total of 33 athletes with patellar tendinopathy were randomized into two groups. PRP + Sham (PS) group received intraarticular injection of autologous PRP (5 mL) once and sham ESWT. PRP + ESWT (PE) group received intraarticular injection of autologous PRP once and after 1 week ESWT (0.2 mJ/mm² energy flux density, 1350 impulses, 4 Hz) once. All patients were followed up for 1 year.</p><p><strong>Results: </strong>Autologous PRP injection and its combination with ESWT are both effective treatments for chronic patellar tendinopathy in athletes. PRP combined with ESWT resulted in faster reduction of knee pain than PRP alone at the 1-month follow-up. Serum IL-33 showed no significant difference at the 12-month follow-up. Levels of interleukin (IL)-6, IL-15, and IL-17 increased at the 12-month follow-up, potentially due to the additional training. However, the athletes did not report any discomfort or injuries, and no abnormalities were detected by ultrasonography after study. We demonstrated improvements in pain and functional scores, as well as knee injury protection in athletes, following 12 months of PRP and PRP with ESWT treatments.</p><p><strong>Conclusions: </strong>The study analyzed the therapeutic effect of PRP injection alone and combining PRP injection with ESWT for chronic patellar tendinopathy. Our results showed that combined treatment can facilitate the pain relief early than PRP alone and is a safety treatment modality. No adverse effect was noted in our study. Trial registration Research registry and the registration number is researchregistry9518. Registered 14 September 2023. https://www.researchregistry.com/browse-the-registry#home/registrationdetails/650263e4f549fd00282a338c/ . The level of evidence is level II.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"47"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying fluid retention following modern pain management in TKA: an observational study.","authors":"Parkpoom Somrak, Aree Tanavalee, Srihatach Ngarmukos, Chotetawan Tanavalee, Chavarin Amarase, Nonn Jaruthien, Wirinaree Kampitak","doi":"10.1186/s43019-024-00251-4","DOIUrl":"10.1186/s43019-024-00251-4","url":null,"abstract":"<p><strong>Background: </strong>Body fluid retention after major surgeries, including total knee arthroplasty (TKA), is well documented in the literature. Currently, multimodal pain control protocols consisting of several medications together with early discharge protocol may magnify this adverse event after a patient's discharge. However, no study has focused on the quantitative and chronological changes in body fluids following modern pain management protocols for TKA. The aim of this study was to investigate the perioperative total body water (TBW) change in patient undergoing TKA.</p><p><strong>Patients and methods: </strong>A consecutive series of 85 patients undergoing primary unilateral TKA, with uniform hospital admission, multimodal pain control, and rehabilitation protocol, had five consecutive multifrequency bioelectrical impedance analysis (BIA) scans; baseline, postoperative day 1 (POD 1), postoperative day 3 (POD 3), 2 weeks, and 6 weeks. Changes in TBW, body weight, corticosteroid-fluid retention dose-response relationship, and complications were evaluated.</p><p><strong>Results: </strong>Seventy patients completed all five scans and follow-ups. Female patients were dominant, with a mean age of 69.5 years. There were no perioperative complications. At 24 h, the mean total fluid input and output were 3695.14 mL and 1983.43 mL, respectively, with 1711.71 mL increments and a mean accumulative dosage of dexamethasone of 15.14 mg. The mean TBW increased by 2.61 L on POD 1 and continued to peak at 3.2 L on POD 3, then gradually decreased at 2 weeks and reached the baseline level at 6 weeks postoperatively. Similarly, the mean body weight increased to 2.8 kg on POD 1, reached the maximum point at 3.42 kg on POD 3, and returned to baseline at 6 weeks.</p><p><strong>Conclusions: </strong>Fluid retention following multimodal pain control in TKA increased from POD 1, peaked on POD 3, and gradually returned to the baseline at 6 weeks. With early discharge protocol, patient education regarding fluid retention after discharge should be considered.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"46"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does septic arthritis after anterior cruciate ligament reconstruction lead to poor outcomes? A systematic review and meta-analysis of observational studies.","authors":"Ashleigh Peng Lin, Bao Tu Thai Nguyen, Son Quang Tran, Yi-Jie Kuo, Shu-Wei Huang, Yu-Pin Chen","doi":"10.1186/s43019-024-00248-z","DOIUrl":"10.1186/s43019-024-00248-z","url":null,"abstract":"<p><strong>Background: </strong>Septic arthritis is a rare but devastating complication after anterior cruciate ligament reconstruction (ACLR). While early treatment can prevent significant graft complications, outcomes are often inferior to those in uncomplicated ACLR. Furthermore, whether to retain or remove the graft after infection remains debatable. Therefore, we sought to compare the outcomes of septic arthritis post ACLR with uncomplicated ACLR and evaluate graft retention versus removal in infected patients.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis in which PubMed, Embase, and Cochrane Library databases were searched. Clinical studies were included if they compared patient-reported, clinician-reported, or radiographic outcomes (minimum follow-up of 12 months) between patients with post-ACLR septic arthritis and those with uncomplicated ACLR or that compared graft retention and removal in patients with post-ACLR septic arthritis.</p><p><strong>Results: </strong>Thirteen studies were retrieved. Patients with post-ACLR septic arthritis reported inferior Lysholm Knee Scoring Scale scores (mean difference (MD) 7.53; 95% confidence interval (CI) 3.20-11.86; P = 0.0006), Tegner Activity Scale scores (MD, 1.42; 95% CI 1.07-1.76; P < .00001), and return to sports rates (53% versus 76%, respectively) to those of patients with uncomplicated ACLR. Patients with post-ACLR septic arthritis and those with uncomplicated ACLR did not differ in terms of the pooled estimate of various clinician-reported outcomes, such as the objective International Knee Documentation Committee score, anterior-posterior laxity, pivot shift, and Lachman test results. Furthermore, no significant difference was noted between the aforementioned patient groups regarding osteoarthritis (detected radiographically). Graft retention led to better patient- and clinician-reported outcomes than graft removal.</p><p><strong>Conclusions: </strong>Despite similar clinician-reported outcomes and osteoarthritis rates, patients with post-ACLR septic arthritis reported worse outcomes than those with uncomplicated ACLR. Graft retention leads to improved patient- and clinician-reported outcomes compared with the outcomes of graft removal. Our findings may help develop realistic expectations and management strategies for this rare complication.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"45"},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}